title: Analysis of postoperative bleeding and risk factors in transoral surgery of the oropharynx.
abstract: OBJECTIVE
  With an increasing incidence of oropharyngeal carcinoma and prevalence of transoral surgical techniques, postoperative bleeding, with its associated risk factors, deserves evaluation.
  
  
  OBJECTIVE
  To classify and review postoropharyngectomy hemorrhage rates and associated risk factors.
  
  
  METHODS
  Single-institution, multicenter retrospective medical chart review analyzing surgical procedures in 906 patients treated with transoral surgery for oropharyngeal carcinoma at a tertiary care, academic referral center from 1994 to 2012. Tumor stage, previous treatment, resection method, and transcervical external carotid branch ligation were analyzed in relationship to postoperative hemorrhage rate, and severity. A novel classification system was created, grading bleeding episodes as minor, intermediate, major, or severe based on management method and related sequelae.
  
  
  RESULTS
  Postoperative bleeding occurred in 5.4% of patients (49 of 906) with 67.3% of these (33 of 49) requiring operative intervention. Severe bleeding episodes were very rare (1.1% of patients). Transcervical external carotid system vessel ligation was performed with the primary resection in 15.6% of patients with no overall difference in bleeding rate or severity of bleeding in patients who underwent ligation vs those who did not (P = .21 and P = .66, respectively). Vessel ligation was performed more frequently in patients with a higher T stage (P = .002). In previously treated patients, severity of bleeding was decreased if vessels were ligated (P > .05). Higher T-stage tumors had a higher bleeding rate (P = .02). Bleeding rates were similar between those treated with laser (5.6%) and robotic (5.9%) oropharyngectomy (P = .80); however, patients with significantly higher T-stage tumors were treated with laser vs robot techniques (P < .001).
  
  
  CONCLUSIONS
  Transoral resection of oropharyngeal carcinoma is safe, and severe life-threatening hemorrhage is rare. Although transcervical vessel ligation did not result in an overall decrease in bleeding rate, there is a trend toward reduced postoropharyngectomy bleeding severity with ligation. We recommend ligation for higher T-stage tumors, primary tonsil tumors, and patients undergoing revision surgery.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix.
authors.forename: Taylor R
authors.initials: TR
authors.lastname: Pollei
authors.forename: Michael L
authors.initials: ML
authors.lastname: Hinni
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Moore
authors.forename: Richard E
authors.initials: RE
authors.lastname: Hayden
authors.forename: Kerry D
authors.initials: KD
authors.lastname: Olsen
authors.forename: John D
authors.initials: JD
authors.lastname: Casler
authors.forename: Logan C
authors.initials: LC
authors.lastname: Walter
mesh_terms: D001130:Arizona / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects* / Q000379:methods; D009959:Oropharyngeal Neoplasms / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012371:Robotics; D012720:Severity of Illness Index